ABSTRACT
OBJECTIVE: To compare laparoscopic and traditional open splenectomy in children with nonmalignant hematologic disorders. STUDY DESIGN: Retrospective review of 36 consecutive nonrandomized splenectomies (16 laparoscopic and 20 open) performed for hematologic disorders at a single pediatric institution during the past 3 years. The two-sided Mann-Whitney U test for non-parametric variables was used for statistical analysis. RESULTS: An open procedure was performed on 20 patients (mean age, 9.7 years), five of whom had a concomitant cholecystectomy. A laparoscopic splenectomy was performed on 16 children (mean age, 10.3 years), seven of whom had a concomitant cholecystectomy. The mean anesthesia and operative times were longer in the laparoscopic than in the open group (p < 0.001). However, the mean number of hours of postoperative analgesia was less in the laparoscopic group (p < 0.005). Patients who had laparoscopic splenectomy were also discharged home earlier (p < 0.01) and resumed a regular diet sooner. Mean operating room charges were higher in the laparoscopic group (p < 0.001), but total hospitalization costs were not significantly different. Postoperative complication rates were similar. The hematologic response was comparable. CONCLUSIONS: laparoscopic splenectomy is feasible and safe in children with hematologic disorders. Although it currently requires more operative time than the open approach, it is superior with regard to duration of postoperative analgesia, duration of hospital stay, and recovery of bowel function.
Subject(s)
Hematologic Diseases/surgery , Laparoscopy , Splenectomy/methods , Adolescent , Analgesia , Analgesics, Opioid/administration & dosage , Analgesics, Opioid/therapeutic use , Anesthesia, General , Child , Child, Preschool , Cholecystectomy , Cholecystectomy, Laparoscopic , Diet , Feasibility Studies , Female , Hospital Charges , Hospital Costs , Hospitalization/economics , Humans , Intestines/physiology , Intraoperative Complications , Laparoscopy/adverse effects , Laparoscopy/economics , Length of Stay , Male , Operating Rooms/economics , Organ Size , Patient Discharge , Postoperative Care , Retrospective Studies , Safety , Splenectomy/adverse effects , Splenectomy/economics , Time FactorsABSTRACT
Partial splenectomy was introduced to achieve the benefits of splenectomy and to avoid the risk of overwhelming infection in patients with symptomatic Gaucher disease. We observed regrowth of the splenic remnant, reemergence of preoperative symptoms, and new bone involvement among most of our patients who had undergone partial splenectomy. Enzyme replacement therapy has markedly limited indications for splenectomy, partial or total, for Gaucher disease.